A few weeks ago I received an unsolicited request from a lawyer in the Midwest asking me whether I would consider being an expert witness in a lawsuit involving a nurse and inappropriate care (resulting in death) of a patient who received an anticoagulant. About 8 months prior, I'd received another unsolicited call, this time from a local staffing agency asking me to provide anticoagulation teaching for staff who would be responsible for administering warfarin to a physically and mentally challenged adolescent.
The truth of the matter is that I never made any connection to the significance of these requests until I read this issue's article on genetic testing for warfarin therapy, the first in our new Decoding Genetics department. As the authors explain, recent research has identified variations in two genes that have been shown to have an important effect on individual response to warfarin. This opens the door to clinicians being able to adjust dosages for genetic differences, as well as patient age, race, weight, diet, medical conditions, and concurrent medications.
I started to think about how challenging it can be to care for patients on heparin and warfarin. Think about how many hours we spend in clinical practice managing these medications, including time spent chasing down lab values and adjusting medication doses in an attempt to keep patients therapeutic. The consequences of not doing so could ultimately result in death from thrombosis or hemorrhage.
A quick search for litigation and anticoagulation yields multiple examples of adverse events related to anticoagulant therapy, including a large number of class action suits filed for both heparin- and warfarin-related issues. However, after reading this issue's Decoding Genetics article, I'm hopeful that genetic testing may help resolve some of the safety issues surrounding anticoagulants.
As you care for your patients on anticoagulants please be mindful of the National Patient Safety Goal: "Reduce the likelihood of patient harm associated with the use of anticoagulant therapy." Follow the protocols that have been put into place in your organization, and remember that these protocols are there to keep your patients safe.
Until the next time: be healthy, be happy, and be great advocates for your patients!!
AnneMarie Palatnik, MSN, RN, APN-BC
Director of Clinical Learning Center for Learning Virtua Health Mount Laurel, N.J. [email protected]